HomeMy WebLinkAboutSUN VALLEY HEIGHTS BLK 5 LT 40/7
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Development Services Department
Building Safety Division
On -Site Water & Wastewater Program o G£ 8�<
- 4700 Elmore Road Z
s P.O. Box 196650 a "
Mark Begich Anchorage, AK 99507 s n E T Y
Mayor www.muni.org/onsite
(907) 343-7904
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue:
Parcel Identification Number: Q 11 - 0 b Z - 4 2
Legal Description
&xn VaMf,, N e��,�%s 6 5 L -1
Pump Installation Date: /2�/� or
Pump Intake Depth Below Top of Well Casing:/I/O feet
Pump Manufacturer's Name: - J
Pump Model: 12- S /
Pump Size 1,5 -hp
Pitless Adapter Burial Depth: feet J.') L.) nJ"C--
Pitless Adapter Manufacturer's Name: /0 0 /V-P—
Pitless Adapter Installer: N d X,-�
Well Disinfected Upon Completion'. Yes ❑ No
Method of Disinfection:,
Comments: (�L[
Property Owame & Address-
.SUr)vne.-uj 1�5k5 5��3
135,V! '%ve
+O'+s;, ANCHORAGE WELL & PUMP SERV.
Pump Installer Name: 330 EAST 76TH AVENUE
ANCHORAGE, AK 99518
PHONE: 907-243-0740
AWPS.COM
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation.
G., ~ER ANCHORAGE AREA BOROn., I
DEr~R'rMENT 0F ENVIRONMENTAL QUALITY
3500 TUDOR ROAD ANCHORAGE, ALASKA 99507 279-8686
INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM
LOCATION
MAILING 7 ( ) ~""/'/~ / PHONE
__ADDRESSZ'Z~ /~(. / ~, j;/~i~_ ~ ~.5']~'
LEGAL DESCRmTJON~'7~ ~S'/,4~<:. f3Zv,../';/Z//j~ 6'(,4
SEPTIC I'ANK:
DISTANCE FROM WELL~-~C:~ i've
LIQUID CAPACII'Y / .c" ~. ~'
t .COMPARTM~NIS.
GALLONS. INSIDE LENGTH INSIDE WIDTH DEPTH
SEEPAGE SYSTEM: SEEPAGE PIT:
NUMBER OF PITS .... / OUTSIDE DIAMETER ~ __OR WIDTH__-/%- ' , LENGTH__ /'~_~, DEPTIt
LINING MATERIAL--(~L: dL'L Zi: /'/r$CA"./2~/<:,~/J~I!).). DISTANCE FROM WELL I~"~lb~'Z~_~~ F~) L;L~, BUILDING FOUNDATION
NEAREST LOT LINE_~(~ '''/~ /J-')~() TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) "/4x~/! SQ. FT.
TILE DRAIN FIELD:
DISTANCE FROM WELl FOUNDATION_
NEAREST LOr LINE
TRENCH WIDTH
DEPTH: TOP OF TILE TO FINISH GRADE
TOTAL LENGTH
, OF LINES
L EFFECTIVE
· DEPTH OF FILTER MATERIAL BENEATH TILE IN. ABOVE TILE__
WELL:
LOT LINE
DISTANCES:
TYPE ~'C;~,'J.-~<, , DEPTH
NEAREST
., SEWER LINE__
WATER
, BUILDING FOUNDAIION .... SAMPLE
SEPTIC ~-1-~"[~)' ~<;~"' !i- SEEPAGE
, TANK_ , SYSTEM ]~(~2 }~!Ucj,, CESSPOOL
DIAGRAM OF SYSTEM
, NEAREST
OTHER
, SOURCES·
DATE
GAAB-HD-2
GREATEr,
327 Eagle St.
kNCHORAGE AREA
HEALTH DEPARTMENT
Anchorage, Alaska 99501
)ROUGH
279-2511
C. e No.
SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT
NAME OF APPI. ICANT~O'-Oq; ¢ [ /~/'~ t~ ¢ _ MAILING ADD,ESS ~'-fO[ ~,
RESIDENCE Al]DRESS ~ ~ &., // LOCATION OF INSTALLATION
APPklCATION TO INSTALk: SEPTIC TANK , SEEPAGE PIT_ ~ , DRAIN FIELD
FINANOED THROUGH TO BE INSTALLED BY_~i C,
PEROOLATION TEST .ESULTS ~//JV~7k _ ANTICIPATED DATE OE COMPLETIOU?
BELOWTO BE FILLED OUTBY HEALTHDEPARTME~T ~
_AS DESCRIBE~p BELOW. SIZE OF UNIT TO BE SERVED
. SEPTIC TANK SIZE ~ .TYPE (~n~ SEEPAGE
DIAGRAM OF SYSTEM
I certify that I am familiar with the requh'ements of Greater Anchorage Area Borough Ordfllance No. 28-68 and that the
above described system is in accordance with said code.
DATE ~- ~'~"///~'.'; /F ~"/ APPLICANTS SIGNATU RE
-'!EATER ANCHORAGE AREA BOROUGH
HUALTH DEPA}<TMENT
327 EAGLE STREET
ANCHORAGE, ALASKA'99501
¢^SF, /I
Depth
Soil Chamact e~,is~ies
Location Sketch
-¸1
· ' .... ~---------.-.--3 ...... "~ ~ep~n To HgO Net Drob
~~_C"', ~ .... :~~ ~~ .....
Proposed Insral~Seepage Pi~ ~-- D~ain Field
Depth Of Inlet
~ ~~~. ~. : .' , . / . .